Healthcare at Home Blog Series: Shifting Policy Landscape

The political landscape and CMS policies are shifting to support the transition of healthcare at home.

THE VBP Blog

picture of the US capitol building

Through our new blog series, Healthcare at Home, we are exploring the transformative healthcare industry shift of utilizing the home as a healthcare hub. In our second blog, we will be reviewing the encouraging policy shifts that could help accelerate the transformation.

It is clear that consumers prefer the convenience of receiving health care at home and there have been encouraging signs in the political landscape as well that the shift towards home care will be supported.

Both the Centers for Medicare & Medicaid Services (CMS) and Congress have shown encouraging signs this summer supporting the shift to healthcare at home. CMS has recently proposed a nationwide expansion of the HHVBP model, while Congress has introduced a bipartisan bill to support home care.  

Proposed HHVBP Model Expansion

The Home Health Value-Based Purchasing (HHVBP) Model was designed to test whether tying payment incentives to quality of care for home health agencies (HHAs) would improve the delivery of home health care services. The pilot was implemented in 2016 in 9 randomly selected states highlighted in the map below.

US map diagram

After years of reporting and analysis, it was determined that the HHVBP model met the requirements for expansion. In 2019, Performance Scores were 8% higher for HHAs in HHVBP states than those in non-HHVBP states, proof that the model assisted patients in receiving better care. In addition to an improvement in care, cumulative Medicare spending was reduced by $604.8 million between 2016 and 2019.

Based on these positive results, CMS proposed a nationwide expansion of the HHVBP model. If the proposed rule is approved, the model would be expanded to all Medicare-certified HHAs nationwide starting January 1, 2022.

While the expansion still needs to be implemented through the rulemaking process in Congress, it is a positive sign that policymakers see the value in providing health care at home. 15 million consumers utilize home care services every year, and the value-based payment model will further incentivize the delivery of high-caliber services to those individuals with payments tied to quality of care.

Choose Home Care Act Introduced with Bipartisan Support

The Choose Home Care Act of 2021 was introduced with bipartisan support by Senators Debbie Stabenow (D-MI) and Todd Young (R-IN).

If enacted, the Choose Home Care Act would enable qualifying Medicare patients recovering from hospitalization to receive extended care services at home instead of in an institutional setting like a skilled nursing facility. The bill aims to give more seniors the option to receive care at home for 30 days after a hospitalization. The legislation modernizes Medicare’s post-acute benefits by offering a new alternative—allowing for recovery in the home. Additional services covered under the program include skilled nursing, therapy service, personal care, remote patient monitoring, and home adaptations, among others.

Starting from the hospital discharge, Choose Home Care services are covered for 30 days with a 100-day maximum. Additionally, home health services can continue beyond 30 days if clinically indicated. Providers will be paid through a combination of the home health benefit episodic payment and a 4-level, 30-day fixed episodic payment. Under the latter, the provider shares financial risk with Medicare.

There is strong evidence that monitored home care treatment can be safer, cheaper, and more effective. This is especially true with COVID-19 as seniors were more susceptible to severe illness from the virus, which spread in hospitals and institutional settings.

Aside from the quantitative benefits, many patients prefer to recover from the comfort of their own homes. In fact, according to a recent survey, 88% of adults would rather receive ongoing living assistance in their own homes as they age. The issue is that only about 16% of adults are confident that they have the financial resources to pay for care in their own homes. The Choose Home Care Act is a value-based alternative that provides access to home care to more Medicare beneficiaries, while also having a projected $247 million annual savings to Medicare.

“The Choose Home Care Act represents a tremendous step forward for Medicare beneficiaries who would prefer to recover at home, but have been previously prevented from doing so under current policy restrictions,” said NAHC President William A. Dombi in a statement.

Cost savings and promoting health equity while allowing patient choice and flexibility have stirred up strong support for this bill.  It is endorsed by industry players like the AARP, National Council on Aging, Moving Health Home, Allies for Independence, the Council of State Home Care & Hospice Associations, and the Forum of State Associations. These groups are strongly urging Congress to quickly pass the bipartisan bill to move the value-based model forward.

Advocate’s Perspective

It is clear that there are many benefits to providing healthcare at home and that it is the preferred method of care delivery for many patients. While the HHVBP expansion and Choose Home Care Act 2021 still need to make their way through the legislative process, it is encouraging to see that policymakers are tying quality care to payments through value-based payment models. We will keep an eye on the status of these VBP models and keep you updated!

Up next in our Healthcare at Home Blog Series – a detailed look at the benefits that healthcare at home offers.

Onward!

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About the Author

Fady Sahhar brings over 30 years of senior management experience working with major multinational companies including Sara Lee, Mobil Oil, Tenneco Packaging, Pactiv, Progressive Insurance, Transitions Optical, PPG Industries and Essilor (France).

His corporate responsibilities included new product development, strategic planning, marketing management, and global sales. He has developed a number of global communications networks, launched products in over 45 countries, and managed a number of branded patented products.

About the Co-Author

Mandy Sahhar provides experience in digital marketing, event management, and business development. Her background has allowed her to get in on the ground floor of marketing efforts including website design, content marketing, and trade show planning. Through her modern approach, she focuses on bringing businesses into the new digital age of marketing through unique approaches and focused content creation. With a passion for communications, she can bring a fresh perspective to an ever-changing industry. Mandy has an MBA with a marketing concentration from Canisius College.